I was at this meeting with Dr. Gillison and others from the OCF Science board. There were some really great presentations, and I had a chance to spend discussion time with lots of doctors to help us understand everything from our future funding projects that seemed important, to catching up on some trials we are already co sponsors of (RTOG1016).

This paper really showed the dominance of HPV in the oropharynx compared to other etiologies. It also showed that survival rates in OPSCC cases are actually pretty good even when distant mets are involved, only 35 people out of the study group of 285 with distant mets didn't make the 5 year mark. If you looked back a data we were presenting before HPV became such a player, this is a huge improvement in overall survival.

The study was also important in this take away, that we have always historically seen the highest percentage of distant met develop very early after primary treatment. Patients that were going to essentially fail primary treatment usually do so very quickly, usually in under a year ( mean 7 months), but in HPV patients it can be much longer, at just under two years, so we really have to monitor them more closely for a longer period of time to be sure that we are catching things as early as possible. In both groups (HPV+ and -) the locations for the distant mets were essentially unchanged with the majority of them to the lungs and the bone. HPV patients, when distant mets occurred, had more sites that were impacted and more sites at the same time as well. So what this means is that the multiple and varied DM sites, which can present as distal localized pain, indicates that we may need to be more aggressive in working up our suspicions for metastatic disease, and that imaging such as PET/CT scans may be warranted even several years after treatment, also that with HPV patients we should not dismiss without exploration what would normally be unspecified pain in what were previously thought to be unlikely metastasis sites.

But for me the impact of this lecture was not about the DM sites being more varied. (Given that most mets went to where they always go in both HPV+ and - patients, I thought the distant met issue was minor and the lecture poorly named.) It was about monitoring more closely after NED for at least two years, especially for HPV+ patients, and that we are doing so much better at long term survival in all patients who have a development of continued disease. I thought the news was a positive note, and for someone that has been watching this for 15 years indicative of how far we have come.